Five-Year Changes in Gait Biomechanics After Concomitant High Tibial Osteotomy and ACL Reconstruction in Patients With Medial Knee Osteoarthritis
Bibliographic record
Abstract
BACKGROUND: Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA). PURPOSE: To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, -5.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, -1.49; 95% CI, -1.75 to -1.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, -0.67; 95% CI, -1.19 to -0.15) and nonsurgical limbs (%BW × H, -1.06; 95% CI, -1.49 to -0.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years. CONCLUSION: Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads. CLINICAL RELEVANCE: These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".